BEST PRACTICE FOR INTEGRATIVE MEDICINE IN AUSTRALIAN MEDICAL PRACTICE: January 2014

https://doi.org/10.1016/j.aimed.2013.12.001Get rights and content

Abstract

The ‘Best Practice for Integrative Medicine in Australian Medical Practice’ is an Australasian Integrative Medicine Association (AIMA) endorsed document as principles to assist medical practitioners for the safe and appropriate integration of evidence-based complementary medicine into medical practice. In Australia, the use of Integrative Medicine (IM) by medical practitioners, particularly general practitioners (GPs) as a part of routine clinical practice is increasing. A National Prescribing Survey (NPS) survey indicated that approximately 30% of GPs in Australia describe themselves as practising IM. About two thirds of Australian consumers have used one or at least one CM in the previous 12 months, with 28% on a regular basis. The document is designed to assist the understanding of IM by the medical profession and for authorities to refer to when seeking guidelines in this field of medicine. The authors undertook an extensive consultation process to develop these principles.

Section snippets

Purpose of the guidelines

These principles aim to provide guidance for the safe and appropriate incorporation of integrative medicine (IM) into medical practice.

Definitions of Integrative Medicine

Integrative Medicine (IM) refers to the blending of conventional and evidence based natural/complementary medicines and/or therapies along with lifestyle interventions and a holistic approach – taking into account the physical, psychological, social and spiritual wellbeing of the person – with the aim of using the most appropriate, safe and evidence-based modality(ies) available.

Integrative medicine embraces and encourages a holistic approach to clinical practice incorporating patient

Standards for Integrative Medicine in Australian General Practice

The standards for integrative medicine for Australian general practice are reflected in the Integrative Medicine statement in the RACGP Curriculum for Australian General Practice2 (Appendix 1).

The Royal Australian College of General Practice (RACGP) is responsible for setting and

Rationale

The use of IM by medical practitioners, particularly general practitioners (GPs) as a part of routine clinical practice is increasing. A National Prescribing Survey (NPS) survey indicated that approximately 30% of GPs in Australia describe themselves as practising IM, by combining orthodox with CM.3

Readership

This document will be available to all medical practitioners education bodies and other specialist colleges, medical associations such as the Australian Medical Association and the Australasian Integrative Medicine Association, the Medical Board of Australia, the Professional Services Review Panel and Medicare Australia. Extensive consultation with some of these groups occurred prior to finalising the Best Practice Guidelines document.

Purpose and aim

The Best Practice for Integrative Medicine in Australian Medical Practice aims to:

  • guide individual medical practitioners in the ethical and appropriate practice of IM in the context of general practice or other clinical medical settings, e.g. specialist medical practitioners,

  • assist regulatory medical and professional bodies by providing suitable standards and guidelines in understanding this area of practice.

Authorship of these guidelines

The Australasian Integrative Medicine Association (AIMA) is constituted by a body of registered medical practitioners around Australia who integrate various forms of complementary medicine (CM) and holistic approaches into their medical practices.5 In recent decades there has been a steady and strong revival of interest in the general and medical communities for more holistic and natural forms of

Preamble

The Australasian Integrative Medicine Association (AIMA) recognises that medicine is not only guided by evidence and science but is also informed by tradition and experience. Current standards allow a wide degree of latitude in medical practitioners’ exercise of their professional judgement and do not preclude the use of any methods that are reasonably likely to benefit patients without undue risk. Furthermore, patients have a right to seek any kind of care for their health problems but it is

Modalities

Modalities will generally be classified under one particular domain but sometimes the modality can overlap with other domains so the following classification is open to interpretation. For example, a philosophical system like Ayurveda also include herbs, mind-body, manual and bio-energetic therapies.

The NCCAM classifies natural, complementary and alternative medicines into five categories, or domains:

Professional decision making in IM

The medical practitioner may offer the patient a conventional and/or CM treatment pursuant to a documented treatment plan tailored to the individual needs of the patient by which treatment progress or success can be evaluated with stated objectives, such as pain relief and/or improved physical and/or psychosocial function. Such a documented treatment plan shall consider pertinent medical history, previous medical records and physical examination, as well as the need for further testing,

Declaration of financial interest

Declaring to your patients your professional and financial interest in any product you might endorse or sell from your practice, and not making an unjustifiable profit from the sale or endorsement. If a practitioner has a financial or other interest in promoting a particular complementary medicine treatment, practitioner, clinic or product then this must be disclosed to patients. Failure to do this may contravene the Trade Practices Act, and be considered misleading or deceptive conduct, and

Communications and relationships

There is strong supporting research on the importance of communications and relationships between the various parties involved in the provision of healthcare for patients and their families/carers.

There are ethical and legal issues at the interface of CM and conventional medicine as addressed in a 2004 article in the Medical Journal of Australia.15

Special areas

The following areas cover patient groups where there may be issues of consent and who may be vulnerable when decisions are made about the use of complementary medicine.

Medical Indemnity Cover

It is recommended that medical practitioners contact their insurer directly to clarify any concerns about their particular area of practice. When making a clinical decision, it is important the doctor weigh the choice of treatments, assesses the scientific evidence (efficacy), any risks associated with the therapy, the clinical outcome (effectiveness) and costs associated with the treatment, and inform patients appropriately. Doctors should discuss with their current or intended indemnity

Patient autonomy, empowerment, paternalism and duty of care

These issues, probably more than any other ethical principle, underpin the rights of patients to choose the healthcare which they consider best for themselves. These factors drive much of the increasing medical and community interest in CM. Facilitated by increasingly easy access to health information and changing community attitudes, more patients are expecting their medical practitioners to be able to use or at least be able to advise about an increasingly broad range of therapies. The right

Long consultations

AIMA, together with the RACGP, supports the use of longer consultations especially in the management of chronic and complex health care problems, mental health problems, support of preventive health care and health promotion in all patients. The RACGP has provided evidence on the quality improvement outcomes arising from longer consultations in support for restructure of the current Medicare Benefit Schedule Attendance Items for General Practice. Complex care of chronic conditions often

Good Medical Practice: A Code of Conduct for Doctors in Australia

The Medical Board of Australia adopted the Code of Conduct.22

It is essential that medical practitioners be aware of the code of conduct of the Medical Board of Australia (MBA). The MBA has formally adopted the Australian Medical Council publication and has published it after making minor changes to reflect practitioners’ obligations under the Health Practitioner

Australian Medical Association

The AMA position statement23 on CM, endorsed in 2002, is provided in the appendices (see Appendix 7).

Medicare Australia

Medicare does not fund therapies that are not supported by the general body of peers. Only when treatments become accepted by the general body of peers, are MBS & PBS benefits able to be claimed. Specifically Medicare is not to be used to fund experimental or clinical trial purposes.

Doctors who practise CM have a tendency for longer consultations which places their Medicare profile outside their peers. Care of complex and chronic health conditions often involves longer consultation times. The

The regulatory framework for complementary medicines in Australia

In Australia, medicinal products containing herbs, vitamins, minerals, and nutritional supplements, homoeopathic medicines and certain aromatherapy products are referred to as ‘complementary medicines’. These are regulated as medicines under the Therapeutics Goods Act 1989 (the Act). Complementary medicines comprise traditional medicines, including traditional Chinese medicines, Ayurvedic medicines and Australian indigenous medicines.24

Advisory Committee on Complementary Medicines (ACCM), TGA

The Advisory Committee on Complementary Medicines (ACCM) was formed in January 2010 to advise and make recommendations to the TGA on the inclusion, variation or retention of a complementary medicine in the Australian Register of Therapeutic Goods.25

ACCM may also provide advice to the TGA on any other

Advisory Committee on the Safety of Medicines (ACSOM), TGA Reporting of adverse drug reactions for CMs

The Advisory Committee on the Safety of Medicines (ACSOM) was formed in January 2010 to advise and make recommendations to the TGA on the:

  • safety of medicines and

  • risk assessment and risk management of medicines.

ACSOM may also provide advice to the TGA on other matters related to the detection, assessment, understanding and prevention of adverse effects, known as pharmacovigilance, and any other matters referred to it by the TGA.

ACSOM supersedes and expands upon the role of the Adverse Drug

Australian College of Nutritional and Environmental Medicine (ACNEM)

http://www.acnem.org/

ACNEM (Australasian College of Nutritional and Environmental Medicine) is a postgraduate medical college established in the early 1980s. It is independent of all governments, government agencies and other organisations and relies on no other body for funding. It is a non-profit organisation, funded from membership fees, subscriptions, courses and other programmes, book sales and donations. The College is set up as an incorporated association.

ACNEM training is designed for

Non medical CM professional bodies

Please refer to the weblinks below to find more information on the codes of ethics, registration criteria and continuing professional development expectations for each discipline.

Education and training

The RACGP has developed an Integrative Medicine Network within its National Faculty of Specific Interests for GPs. In future this Network may be able to offer an accreditation system and education standards for doctors practising in Australia under the umbrella of the RACGP.

Conclusion

The authors recognise that legitimate standards of medical practice are rooted in competent and reliable scientific evidence and clinical experience. However, these standards are subject to continual change and improvement as advances are made in scientific research and analysis. In addition, standards of medical practice to some degree and the provision of medical services in individual circumstances in particular, are influenced by psychological, social, political and market forces. It is the

Acknowledgments

The ‘Best Practice for Integrative Medicine in Australian Medical Practice’ is an AIMA endorsed document originally developed by the RACGP/AIMA Joint Working Party (JWP) as principles to assist medical practitioners for the safe and appropriate integration of evidence-based complementary medicine into medical practice. These principles were originally adapted from the ‘Model Guidelines for the Use of Complementary and Alternative Therapies in Medical Practice’ (A Policy Document of the

References (0)

Cited by (10)

  • Integrative Medicine in Equine Practice

    2022, Veterinary Clinics of North America - Equine Practice
    Citation Excerpt :

    However, the best philosophy or true approach of integrative medicine is to use a combination of all diagnostic and treatment options available with equal regard for their specific indications, safety, and clinical efficacy (eg, arthroscopic surgery combined with postoperative rehabilitation).27 The selected treatment plan should include the following considerations:5 Is based on the best available evidence to support its clinical use and effectiveness

  • Barriers to the conduct and application of research among complementary and alternative medicine professions in Australia and New Zealand: A cross-sectional survey

    2021, Complementary Therapies in Medicine
    Citation Excerpt :

    As a means of ensuring methodological rigour, the selection of CAM disciplines for this study was underpinned by four processes. ( a) Mapping the CAM disciplines most frequently reported across various frameworks 39–41; (b) Targeting the largest and the most prevalent forms of CAM used in the Trans-Tasman region 32,42; (c) Identifying disciplines reported in the National Centre for Complementary and Alternative Medicine definition of CAM, 43 and (d) Isolating CAM disciplines included in CAM-specific Trans-Tasman Practitioner-Based Research Networks. 31 The selection of Australia and New Zealand was underpinned by methodological (i.e., similar models of care and professional regulatory structures, as well as Trans-Tasman mutual recognition principles, 44 pragmatic (i.e. limited time and resources to recruit beyond the Trans-Tasman region) and logistical (i.e. ease of access to CAM practitioner networks, similar time-zones) reasons.

  • Mindful Library Leadership

    2016, The Mindful Librarian: Connecting the Practice of Mindfulness to Librarianship
View all citing articles on Scopus
View full text